Provider Demographics
NPI:1457343527
Name:SCARBOROUGH, DWIGHT A (MD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:A
Last Name:SCARBOROUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SHAWAN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2100
Mailing Address - Country:US
Mailing Address - Phone:614-764-1711
Mailing Address - Fax:614-889-2652
Practice Address - Street 1:650 SHAWAN FALLS DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2100
Practice Address - Country:US
Practice Address - Phone:614-764-1711
Practice Address - Fax:614-889-2652
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045403207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1351OtherRR MEDICARE GRP ID
OH070003697OtherRR MEDICARE ID
OH070003697OtherRR MEDICARE ID
OH9932361Medicare PIN
OH0542585Medicare PIN